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Tumor markers effectively detect relapse in pediatric germ cell tumors
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Monitoring tumor markers may be an effective relapse-detection strategy for certain children with nongerminomatous malignant germ cell tumors, according to a study published in Journal of Clinical Oncology.
Such an approach may potentially reduce the number of imaging studies required, according to the researchers.
“We hypothesized that malignant germ cell tumors with elevated tumor markers at diagnosis would be amenable to monitoring with serial alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin measurements, thus allowing a reduction or avoidance of ionized radiation-based imaging,” Adriana Fonseca, MD, hematology/oncology fellow at Hospital for Sick Children and the department of pediatrics at University of Toronto, and colleagues wrote. “To explore this hypothesis, we sought to determine the detection method of all relapses in a recent malignant germ cell tumor (MGCT) trial conducted by the Children’s Oncology Group.”
Fonseca and colleagues retrospectively evaluated clinical trial data from 284 patients (median age, 10 years; range 0-20; 43% male) with low- and intermediate-risk MGCTs enrolled in the single-arm phase 3 COG AGT0132 study between 2003 and 2011.
Patients with low-risk disease (n = 104) had stage 1 ovarian and testicular germ cell tumors and were prescribed observation alone, with chemotherapy in the event of a relapse. Those in the intermediate-risk group (n = 180) had stage 2 to stage 4 testicular tumors, stage 2 to stage 4 ovarian tumors, stage 1 to stage 2 extragonadal tumors, or experienced relapse or progression while on observation in the low-risk group. Patients in this group received adjuvant chemotherapy.
The researchers assessed methods for detecting relapse based on case report forms, tumor markers, imaging and pathology reports. They classified relapses as detectable by tumor marker increase or not detectable by tumor markers.
Nearly all of the patients (97.5%, n = 277) had elevated tumor markers.
Median follow-up was 5.3 years (95% CI, 4.1- 5.5).
none of the seven patients with normal tumor markers at diagnosis experienced a relapse.
Overall, 48 patients (16.9%) experienced relapse. Median time from enrollment to relapse was 134.5 days (range, 19-440).
Central review revealed that 47 of the relapses (98%) were identified through tumor marker elevation. Of these patients, 16 (33.3%) had abnormal tumor markers with normal or unknown imaging, 31 patients (64.6%) had abnormal tumor markers and abnormal imaging, and one patient (2.1%) had abnormal imaging and unknown tumor marker levels at relapse.
Based on institutional preference, all relapsed patients received additional therapy.
According to the researchers, these findings will not obviate the need for imaging studies.
“For those patients with negative tumor markers at diagnosis, such as patients with seminoma/dysgerminoma or embryonal carcinoma, surveillance with serial imaging will still be indispensable,” the researchers wrote. “On the basis of this retrospective review, we propose to evaluate in a prospective clinical trial the value added of frequent surveillance imaging in children, adolescents and young adults with marker-positive vs. marker-negative MGCTs.” – by Jennifer Byrne
Disclosures: Fonseca reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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